Common use of Licensure/Certification Clause in Contracts

Licensure/Certification. Classified employees who have earned a certificate or a degree, diploma, certification and/or licensure related to their job position may qualify for a stipend of $100/$300/$500 per year to a maximum of $2,500* per employee per year. (The maximum of $2,500 per employee is subject to review at the initial committee meeting.) In order to qualify for this additional stipend, the following criteria must be met: ■ Certificate / degree, diploma, certification and/or license must be specific to current job. ■ Receipt of certificate / degree, diploma, certification and/or license must be from a recognized state or national level trade or professional institution. ■ Knowledge/skill outcomes from the certificate / degree, diploma, certification and/or license must be designed to improve knowledge/skills that are beyond current job description requirements. ■ Requirements for the certificate / degree, diploma, certification and/or license must be completed primarily on the employee’s own time. Any full time classified employee who meets the established criteria may request the stipend pay by completing and submitting the application (APPENDIX B). Applications will be reviewed by the certification team, consisting of the Superintendent, Treasurer, and Classified Supervisor, who will make a determination as to eligibility for a stipend. LEVEL I - $100 STIPEND A certificate from an Adult/Continuing Education program, which requires 50 or more seat hours of instruction, will be considered for a $100 stipend. All classes must be on the same topic and apply to the employee’s job field. The employee must complete the entire course schedule for the program, subject to committee review. LEVEL II - $300 STIPEND A certificate from an Adult/Continuing Education program, which requires 100 or more seat hours of instruction, will be considered for a $300 stipend. All classes must be on the same topic and apply to the employee’s job field. The employee must complete the entire course schedule for the program, subject to committee review. LEVEL III- $500 STIPEND In order to be approved for certification/licensure pay at the $500 level, employees must have a degree, diploma, license or certification from the State of Ohio or a recognized state or national level trade or professional institution. Applications will be reviewed on a semi-annual basis by the certification team. Deadlines for applying for certification/licensure pay are the first working day of January and September. Applications should be submitted to the Treasurer and must be received by the end of the working day deadline. Applications received after the deadline will be reviewed for the following period. Xxxxxxxx will be paid with regular wages in the first pay in February for those meeting the January deadline and the first pay in October for those meeting the September deadline. If the certification or license is one that expires, it is the employee’s responsibility to submit documentation of renewal to the Treasurer. Failure to submit this documentation of renewal at the time of expiration will result in the loss of the certification/licensure stipend. APPENDIX A1- 2015/2016 School Year $150.00 Deductible Plan/ RX A 1 OF 6 XXXXX X. XXXXXXXX LOCAL SCHOOLS COMPREHENSIVE MAJOR MEDICAL BENEFITS Precertification Review: Precertification review is required for all inpatient Hospital confinements. For elective stays, certification is required at least 24 hours prior to admission. For emergency admissions, certification is required within 48 hours following admission. If preadmission Hospital certification is not utilized, your benefits under the plan will be reduced by an additional $500.00 deductible. All benefits will be based upon Allowed Amount Annual Maximum Amount Payable per Individual No Limit Network (PPO Providers) Physician/Office Services (co-pay) Primary Care Specialist Office Visit $10.00 $20.00 Surgical Services $10.00 $20.00 Immunizations $10.00 $20.00 Allergy Testing $10.00 Speech Therapy $20 co-pay Physical/Chiropractic/Occupational Therapy $20 co-pay Urgent Care $35.00 co-pay Calendar Year Deductible: $20.00 Per Individual $150.00 Per Family $300.00 Then: all eligible charges will be paid at 90% until the maximum out-of-pocket amount has been satisfied. With: 100% payment on eligible charges thereafter for that individual for the remainder of that calendar year. Maximum Out-of-Pocket Expense per Calendar Year (including the deductible): Per Individual $650.00 Per Family $1,300.00 Non-Network (Non-PPO Providers) Physician/Office Services (co-pay) Primary Care/Specialist Office Visit 20% after deductible Surgical Services 20% after deductible Immunizations 20% after deductible Allergy Testing 20% after deductible Speech Therapy 20% after deductible Physical/Chiropractic/Occupational Therapy 20% after deductible Urgent Care 20% after deductible Calendar Year Deductible: Per Individual $300.00 Per Family $600.00 Then: all eligible charges will be paid at 80% until the maximum out-of-pocket amount has been satisfied. With: 100% payment on eligible charges thereafter for that individual for the remainder of that calendar year. Maximum Out-of-Pocket Expense per Calendar Year (including the deductible): Per Individual $1,300.00 Per Family $2,600.00 COVERED SERVICES Subject to deductible and co-pay unless otherwise stated: Percentage Payable Network Non-Network Maximum Daily Room Charge (In Hospital) 90% 80% Private Room Rate (The Hospital's average semi-private room rate) 90% 80% Special Care Unit (ICU & CCU) 90% 80% Inpatient Miscellaneous Charges 90% 80% Inpatient Physicians Visits 90% 80% Preadmission Testing (deductible does not apply) 100% 100% Diagnostic X-ray and Lab 90% 80% Consultation Expenses 90% 80% Surgical Expense Benefits 90% 80% Voluntary Second Surgical Opinion (deductible does not apply) 100% 100% Outpatient Surgery 90% 80% Durable Medical Equipment 90% 80% Anesthesia 90% 80% Ambulance Services 90% 80% Emergency Room Treatment - Life Threatening Accident $75.00 co-pay Then 100% Then 100% Care received within 90 days as long as initial treatment is received within 72 hours of accident Emergency Room Treatment- Life Threatening Illness 90% 90% Emergency Room Treatment - Non-Life Threatening Accident. $75.00 co-pay Then 90% Then 80% Care received within 90 days as long as initial treatment is received within 72 hours of accident Emergency Room Treatment- Non Life Threatening $75.00 co-pay Then 90% Then 80% Physician Office Visits 90% 80% Injectable Prescription Drugs 90% 80% Percentage Payable Network Non-Network Deductible and Co-pay does not apply In Network: Wellness Benefits 100% 20% after deductible Women's Preventive Health 100% 20% after deductible Mammogram 100% 20% after deductible Pap Smear or Prostate Exam 100% 20% after deductible Maximum: 1 per Calendar Year Well Child Benefit (Age 1 - Age 21) 100% 20% after deductible Well Baby Benefit (Birth - Age 1) 100% 20% after deductible Colon and Rectal Exam (Age 40 and Over) 100% 20% after deductible Maximum: 1 per Calendar Year Genetic Testing (not subject to deductible) 100% Not Covered Therapy Services 90% 80% (Includes medically necessary cardiac rehabilitation, radiation therapy, chemotherapy, dialysis, physical therapy, speech therapy, and occupational therapy) Skilled Nursing/Rehabilitation Facility 90% 80% Private Duty Nursing 90% 80% Home Health Care 90% 80% Calendar Year Maximum: 100 visits Hospice Care Deductible does not apply Lifetime Maximum: 6 months 80% 80% Transplants 90% 80% Mental/Nervous Disorders Inpatient 90% 80% Outpatient 90% 80% Alcohol & Substance Abuse Inpatient 90% 80% Outpatient 90% 80% PPO PROVISIONS Treatment from Non-PPO (Non-Network) Providers in Certain Circumstances. In the following situations, services rendered by a Non-Network provider will be considered at the Network level: • Ancillary providers rendering care in a PPO facility (i.e.: pathologist, radiologist, anesthesiologist, emergencyroom physician); • If a Covered Person has no choice of network providers in the specialty that the Covered Person is seeking within the PPO service area; • If a Covered Person is out of the PPO service area and has a medical emergency requiring immediate care; • When a PPO provider utilizes the services of a Non-PPO provider for the reading or interpretation of x-ray or laboratory tests; • If a Covered Person does not live within a 30-mile radius of a PPO facility or is referred to an Out of Network Provider. • Eligible Dependent Children who reside outside of Primary PPO service area. However, in these instances, the individual may be responsible for charges in excess of the Allowed Amount. Please call the Claims Administrator if you believe any of these provisions apply to you. Prescription Drug Benefits as follows: Non-Formulary Formulary Generic Retail $25.00 co-pay $10.00 co-pay $5.00 co-pay Mail Order- 90 Day $50.00 co-pay $20.00 co-pay $10.00 co-pay Dental Plan Calendar Year Deductible In-Network $25.00 Out-of-Network $25.00 Family Limit- 2 per family Waived for Preventative Charges Covered Plan Pays (on average) In-Network Out-of-Network Preventative Care Cleaning (prophylaxis) Frequency- Twice per Calendar Year Fluoride Treatments (No age limits) Oral Exams Periodontal Maintenance (2 additional payable with history of perio disease) Sealants (per tooth) X-rays 100% 100% Basic Care Anesthesia Fillings (Restrictions may apply to composite fillings) Inlays, Onlays, Veneers (subject to necessity requirements) Perio Surgery Repair & Maintenance of Crowns, Bridges & Dentures Root Canal Scaling & Root Planing (per quadrant) Simple Extractions Single Crowns Surgical Extractions 80% 80% Major Care Bridges and Dentures 80% 80% Orthodontia Limits: Child(ren) 60% 60% Annual Maximum Benefit $2000.00 $2000.00 Lifetime Orthodontia Benefit $2000.00 Dependent Age Limits 26 Genetic Testing and Surgical Procedures for High Risk Patients – Genetic Testing The appropriateness of genetic testing must be demonstrated in medical records which identify the patient as having a strong family history of breast cancer and/or ovarian cancer. Family history is defined by any of the following criteria: • Multiple relatives are affected; • Relatives including self were diagnosed at comparatively younger ages than is typical (prior to age 50); • Relatives have multiple primary cancers; • There is an autosomal dominant pattern that indicates that the patient is in a common genetic path with her affected relatives. Results A patient in any of the following circumstances may be considered high risk: • A mutated BRCA gene found by genetic testing; • Lobular neoplasia (fluid type 2), also referred to as LCIS or lobular carcinoma in situ (this pertains to removal of the uninvolved breast); • Atypical lobular hyperplasia, type 1.

Licensure/Certification. Classified employees who have earned a certificate or a degree, diploma, certification and/or licensure related to their job position may qualify for a stipend of $100/$300/$500 per year to a maximum of $2,500* per employee per year. (The maximum of $2,500 per employee is subject to review at the initial committee meeting.) In order to qualify for this additional stipend, the following criteria must be met: ■ Certificate / degree, diploma, certification and/or license must be specific to current job. ■ Receipt of certificate / degree, diploma, certification and/or license must be from a recognized state or national level trade or professional institution. ■ Knowledge/skill outcomes from the certificate / degree, diploma, certification and/or license must be designed to improve knowledge/skills that are beyond current job description requirements. ■ Requirements for the certificate / degree, diploma, certification and/or license must be completed primarily on the employee’s own time. Any full time classified employee who meets the established criteria may request the stipend pay by completing and submitting the application (APPENDIX B). Applications will be reviewed by the certification team, consisting of the Superintendent, Treasurer, and Classified Supervisor, who will make a determination as to eligibility for a stipend. LEVEL I - $100 STIPEND A certificate from an Adult/Continuing Education program, which requires 50 or more seat hours of instruction, will be considered for a $100 stipend. All classes must be on the same topic and apply to the employee’s job field. The employee must complete the entire course schedule for the program, subject to committee review. LEVEL II - $300 STIPEND A certificate from an Adult/Continuing Education program, which requires 100 or more seat hours of instruction, will be considered for a $300 stipend. All classes must be on the same topic and apply to the employee’s job field. The employee must complete the entire course schedule for the program, subject to committee review. LEVEL III- $500 STIPEND In order to be approved for certification/licensure pay at the $500 level, employees must have a degree, diploma, license or certification from the State of Ohio or a recognized state or national level trade or professional institution. Applications will be reviewed on a semi-annual basis by the certification team. Deadlines for applying for certification/licensure pay are the first working day of January and September. Applications should be submitted to the Treasurer and must be received by the end of the working day deadline. Applications received after the deadline will be reviewed for the following period. Xxxxxxxx will be paid with regular wages in the first pay in February for those meeting the January deadline and the first pay in October for those meeting the September deadline. If the certification or license is one that expires, it is the employee’s responsibility to submit documentation of renewal to the Treasurer. Failure to submit this documentation of renewal at the time of expiration will result in the loss of the certification/licensure stipend. APPENDIX A1- 2015/2016 School Year $150.00 Deductible Plan/ RX A 1 OF 6 XXXXX X. XXXXXXXX LOCAL SCHOOLS COMPREHENSIVE MAJOR MEDICAL BENEFITS Precertification Review: Precertification review is required for all inpatient Hospital confinements. For elective stays, certification is required at least 24 hours prior to admission. For emergency admissions, certification is required within 48 hours following admission. If preadmission Hospital certification is not utilized, your benefits under the plan will be reduced by an additional $500.00 deductible. All benefits will be based upon Allowed Amount Annual Maximum Amount Payable per Individual No Limit Network (PPO Providers) Physician/Office Services (co-pay) Primary Care Specialist Office Visit $10.00 $20.00 Surgical Services $10.00 $20.00 Immunizations $10.00 $20.00 Allergy Testing $10.00 Speech Therapy $20 co-pay Physical/Chiropractic/Occupational Therapy $20 co-pay Urgent Care $35.00 co-pay Calendar Year Deductible: $20.00 Per Individual $150.00 Per Family $300.00 Then: all eligible charges will be paid at 90% until the maximum out-of-pocket amount has been satisfied. With: 100% payment on eligible charges thereafter for that individual for the remainder of that calendar year. Maximum Out-of-Pocket Expense per Calendar Year (including the deductible): Per Individual $650.00 Per Family $1,300.00 Non-Network (Non-PPO Providers) Physician/Office Services (co-pay) Primary Care/Specialist Office Visit 20% after deductible Surgical Services 20% after deductible Immunizations 20% after deductible Allergy Testing 20% after deductible Speech Therapy 20% after deductible Physical/Chiropractic/Occupational Therapy 20% after deductible Urgent Care 20% after deductible Calendar Year Deductible: Per Individual $300.00 Per Family $600.00 Then: all eligible charges will be paid at 80% until the maximum out-of-pocket amount has been satisfied. With: 100% payment on eligible charges thereafter for that individual for the remainder of that calendar year. Maximum Out-of-Pocket Expense per Calendar Year (including the deductible): Per Individual $1,300.00 Per Family $2,600.00 COVERED SERVICES Subject to deductible and co-pay unless otherwise stated: Percentage Payable Network Non-Network Maximum Daily Room Charge (In Hospital) 90% 80% Private Room Rate (The Hospital's average semi-private room rate) 90% 80% Special Care Unit (ICU & CCU) 90% 80% Inpatient Miscellaneous Charges 90% 80% Inpatient Physicians Visits 90% 80% Preadmission Testing (deductible does not apply) 100% 100% Diagnostic X-ray and Lab 90% 80% Consultation Expenses 90% 80% Surgical Expense Benefits 90% 80% Voluntary Second Surgical Opinion (deductible does not apply) 100% 100% Outpatient Surgery 90% 80% Durable Medical Equipment 90% 80% Anesthesia 90% 80% Ambulance Services 90% 80% Emergency Room Treatment - Life Threatening Accident $75.00 co-pay Then 100% Then 100% Care received within 90 days as long as initial treatment is received within 72 hours of accident Emergency Room Treatment- Life Threatening Illness 90% 90% Emergency Room Treatment - Non-Life Threatening Accident. $75.00 co-pay Then 90% Then 80% Care received within 90 days as long as initial treatment is received within 72 hours of accident Emergency Room Treatment- Non Life Threatening $75.00 co-pay Then 90% Then 80% Physician Office Visits 90% 80% Injectable Prescription Drugs 90% 80% Percentage Payable Network Non-Network Deductible and Co-pay does not apply In Network: Wellness Benefits 100% 20% after deductible Women's Preventive Health 100% 20% after deductible Mammogram 100% 20% after deductible Pap Smear or Prostate Exam 100% 20% after deductible Maximum: 1 per Calendar Year Well Child Benefit (Age 1 - Age 21) 100% 20% after deductible Well Baby Benefit (Birth - Age 1) 100% 20% after deductible Colon and Rectal Exam (Age 40 and Over) 100% 20% after deductible Maximum: 1 per Calendar Year Genetic Testing (not subject to deductible) 100% Not Covered Therapy Services 90% 80% (Includes medically necessary cardiac rehabilitation, radiation therapy, chemotherapy, dialysis, physical therapy, speech therapy, and occupational therapy) Skilled Nursing/Rehabilitation Facility 90% 80% Private Duty Nursing 90% 80% Home Health Care 90% 80% Calendar Year Maximum: 100 visits Hospice Care Deductible does not apply Lifetime Maximum: 6 months 80% 80% Transplants 90% 80% Mental/Nervous Disorders Inpatient 90% 80% Outpatient 90% 80% Alcohol & Substance Abuse Inpatient 90% 80% Outpatient 90% 80% PPO PROVISIONS Treatment from Non-PPO (Non-Network) Providers in Certain Circumstances. In the following situations, services rendered by a Non-Network provider will be considered at the Network level: • Ancillary providers rendering care in a PPO facility (i.e.: pathologist, radiologist, anesthesiologist, emergencyroom physician); • If a Covered Person has no choice of network providers in the specialty that the Covered Person is seeking within the PPO service area; • If a Covered Person is out of the PPO service area and has a medical emergency requiring immediate care; • When a PPO provider utilizes the services of a Non-PPO provider for the reading or interpretation of x-ray or laboratory tests; • If a Covered Person does not live within a 30-mile radius of a PPO facility or is referred to an Out of Network Provider. • Eligible Dependent Children who reside outside of Primary PPO service area. However, in these instances, the individual may be responsible for charges in excess of the Allowed Amount. Please call the Claims Administrator if you believe any of these provisions apply to you. Prescription Drug Benefits as follows: Non-Formulary Formulary Generic Retail $25.00 co-pay $10.00 co-pay $5.00 co-pay Mail Order- 90 Day $50.00 co-pay $20.00 co-pay $10.00 co-pay Dental Plan Calendar Year Deductible In-Network $25.00 Out-of-Network $25.00 Family Limit- 2 per family Waived for Preventative Charges Covered Plan Pays (on average) In-Network Out-of-Network Preventative Care Cleaning (prophylaxis) Frequency- Twice per Calendar Year Fluoride Treatments (No age limits) Oral Exams Periodontal Maintenance (2 additional payable with history of perio disease) Sealants (per tooth) X-rays 100% 100% Basic Care Anesthesia Fillings (Restrictions may apply to composite fillings) Inlays, Onlays, Veneers (subject to necessity requirements) Perio Surgery Repair & Maintenance of Crowns, Bridges & Dentures Root Canal Scaling & Root Planing (per quadrant) Simple Extractions Single Crowns Surgical Extractions 80% 80% Major Care Bridges and Dentures 80% 80% Orthodontia Limits: Child(ren) 60% 60% Annual Maximum Benefit $2000.00 $2000.00 Lifetime Orthodontia Benefit $2000.00 Dependent Age Limits 26 Genetic Testing and Surgical Procedures for High Risk Patients – Genetic Testing The appropriateness of genetic testing must be demonstrated in medical records which identify the patient as having a strong family history of breast cancer and/or ovarian cancer. Family history is defined by any of the following criteria: • Multiple relatives are affected; • Relatives including self were diagnosed at comparatively younger ages than is typical (prior to age 50); • Relatives have multiple primary cancers; • There is an autosomal dominant pattern that indicates that the patient is in a common genetic path with her affected relatives. Results A patient in any of the following circumstances may be considered high risk: • A mutated BRCA gene found by genetic testing; • Lobular neoplasia (fluid type 2), also referred to as LCIS or lobular carcinoma in situ (this pertains to removal of the uninvolved breast); • Atypical lobular hyperplasia, type 1.

Licensure/Certification. Classified employees who have earned a certificate or a degree, diploma, certification and/or licensure related to their job position may qualify for a stipend of $100/$300/$500 per year to a maximum of $2,500* per employee per year. (The maximum of $2,500 per employee is subject to review at the initial committee meeting.) In order to qualify for this additional stipend, the following criteria must be met: ■ Certificate / degree, diploma, certification and/or license must be specific to current job. ■ Receipt of certificate / degree, diploma, certification and/or license must be from a recognized state or national level trade or professional institution. ■ Knowledge/skill outcomes from the certificate / degree, diploma, certification and/or license must be designed to improve knowledge/skills that are beyond current job description requirements. ■ Requirements for the certificate / degree, diploma, certification and/or license must be completed primarily on the employee’s own time. Any full time classified employee who meets the established criteria may request the stipend pay by completing and submitting the application (APPENDIX B). Applications will be reviewed by the certification team, consisting of the Superintendent, Treasurer, and Classified Supervisor, who will make a determination as to eligibility for a stipend. LEVEL I - $100 STIPEND A certificate from an Adult/Continuing Education program, which requires 50 or more seat hours of instruction, will be considered for a $100 stipend. All classes must be on the same topic and apply to the employee’s job field. The employee must complete the entire course schedule for the program, subject to committee review. LEVEL II - $300 STIPEND A certificate from an Adult/Continuing Education program, which requires 100 or more seat hours of instruction, will be considered for a $300 stipend. All classes must be on the same topic and apply to the employee’s job field. The employee must complete the entire course schedule for the program, subject to committee review. LEVEL III- $500 STIPEND In order to be approved for certification/licensure pay at the $500 level, employees must have a degree, diploma, license or certification from the State of Ohio or a recognized state or national level trade or professional institution. Applications will be reviewed on a semi-annual basis by the certification team. Deadlines for applying for certification/licensure pay are the first working day of January and September. Applications should be submitted to the Treasurer and must be received by the end of the working day deadline. Applications received after the deadline will be reviewed for the following period. Xxxxxxxx Stipends will be paid with regular wages in the first pay in February for those meeting the January deadline and the first pay in October for those meeting the September deadline. If the certification or license is one that expires, it is the employee’s responsibility to submit documentation of renewal to the Treasurer. Failure to submit this documentation of renewal at the time of expiration will result in the loss of the certification/licensure stipend. APPENDIX A1- 2015/2016 School Year $150.00 Deductible Plan/ RX A 1 OF 6 XXXXX X. XXXXXXXX LOCAL SCHOOLS COMPREHENSIVE MAJOR MEDICAL BENEFITS Precertification Review: Precertification review is required for all inpatient Hospital confinements. For elective stays, certification is required at least 24 hours prior to admission. For emergency admissions, certification is required within 48 hours following admission. If preadmission Hospital certification is not utilized, your benefits under the plan will be reduced by an additional $500.00 deductible. All benefits will be based upon Allowed Amount Annual Maximum Amount Payable per Individual No Limit Network (PPO Providers) Physician/Office Services (co-pay) Primary Care Specialist Office Visit $10.00 $20.00 Surgical Services $10.00 $20.00 Immunizations $10.00 $20.00 Allergy Testing $10.00 Speech Therapy $20 co-pay Physical/Chiropractic/Occupational Therapy $20 co-pay Urgent Care $35.00 co-pay Calendar Year Deductible: $20.00 Per Individual $150.00 Per Family $300.00 Then: all eligible charges will be paid at 90% until the maximum out-of-pocket amount has been satisfied. With: 100% payment on eligible charges thereafter for that individual for the remainder of that calendar year. Maximum Out-of-Pocket Expense per Calendar Year (including the deductible): Per Individual $650.00 Per Family $1,300.00 Non-Network (Non-PPO Providers) Physician/Office Services (co-pay) Primary Care/Specialist Office Visit 20% after deductible Surgical Services 20% after deductible Immunizations 20% after deductible Allergy Testing 20% after deductible Speech Therapy 20% after deductible Physical/Chiropractic/Occupational Therapy 20% after deductible Urgent Care 20% after deductible Calendar Year Deductible: Per Individual $300.00 Per Family $600.00 Then: all eligible charges will be paid at 80% until the maximum out-of-pocket amount has been satisfied. With: 100% payment on eligible charges thereafter for that individual for the remainder of that calendar year. Maximum Out-of-Pocket Expense per Calendar Year (including the deductible): Per Individual $1,300.00 Per Family $2,600.00 COVERED SERVICES Subject to deductible and co-pay unless otherwise stated: Percentage Payable Network Non-Network Maximum Daily Room Charge (In Hospital) 90% 80% Private Room Rate (The Hospital's average semi-private room rate) 90% 80% Special Care Unit (ICU & CCU) 90% 80% Inpatient Miscellaneous Charges 90% 80% Inpatient Physicians Visits 90% 80% Preadmission Testing (deductible does not apply) 100% 100% Diagnostic X-ray and Lab 90% 80% Consultation Expenses 90% 80% Surgical Expense Benefits 90% 80% Voluntary Second Surgical Opinion (deductible does not apply) 100% 100% Outpatient Surgery 90% 80% Durable Medical Equipment 90% 80% Anesthesia 90% 80% Ambulance Services 90% 80% Emergency Room Treatment - Life Threatening Accident $75.00 co-pay Then 100% Then 100% Care received within 90 days as long as initial treatment is received within 72 hours of accident Emergency Room Treatment- Life Threatening Illness 90% 90% Emergency Room Treatment - Non-Life Threatening Accident. $75.00 co-pay Then 90% Then 80% Care received within 90 days as long as initial treatment is received within 72 hours of accident Emergency Room Treatment- Non Life Threatening $75.00 co-pay Then 90% Then 80% Physician Office Visits 90% 80% Injectable Prescription Drugs 90% 80% Percentage Payable Network Non-Network Deductible and Co-pay does not apply In Network: Wellness Benefits 100% 20% after deductible Women's Preventive Health 100% 20% after deductible Mammogram 100% 20% after deductible Pap Smear or Prostate Exam 100% 20% after deductible Maximum: 1 per Calendar Year Well Child Benefit (Age 1 - Age 21) 100% 20% after deductible Well Baby Benefit (Birth - Age 1) 100% 20% after deductible Colon and Rectal Exam (Age 40 and Over) 100% 20% after deductible Maximum: 1 per Calendar Year Genetic Testing (not subject to deductible) 100% Not Covered Therapy Services 90% 80% (Includes medically necessary cardiac rehabilitation, radiation therapy, chemotherapy, dialysis, physical therapy, speech therapy, and occupational therapy) Skilled Nursing/Rehabilitation Facility 90% 80% Private Duty Nursing 90% 80% Home Health Care 90% 80% Calendar Year Maximum: 100 visits Hospice Care Deductible does not apply Lifetime Maximum: 6 months 80% 80% Transplants 90% 80% Mental/Nervous Disorders Inpatient 90% 80% Outpatient 90% 80% Alcohol & Substance Abuse Inpatient 90% 80% Outpatient 90% 80% PPO PROVISIONS Treatment from Non-PPO (Non-Network) Providers in Certain Circumstances. In the following situations, services rendered by a Non-Network provider will be considered at the Network level: • Ancillary providers rendering care in a PPO facility (i.e.: pathologist, radiologist, anesthesiologist, emergencyroom physician); • If a Covered Person has no choice of network providers in the specialty that the Covered Person is seeking within the PPO service area; • If a Covered Person is out of the PPO service area and has a medical emergency requiring immediate care; • When a PPO provider utilizes the services of a Non-PPO provider for the reading or interpretation of x-ray or laboratory tests; • If a Covered Person does not live within a 30-mile radius of a PPO facility or is referred to an Out of Network Provider. • Eligible Dependent Children who reside outside of Primary PPO service area. However, in these instances, the individual may be responsible for charges in excess of the Allowed Amount. Please call the Claims Administrator if you believe any of these provisions apply to you. Prescription Drug Benefits as follows: Non-Formulary Formulary Generic Retail $25.00 co-pay $10.00 co-pay $5.00 co-pay Mail Order- 90 Day $50.00 co-pay $20.00 co-pay $10.00 co-pay Dental Plan Calendar Year Deductible In-Network $25.00 Out-of-Network $25.00 Family Limit- 2 per family Waived for Preventative Charges Covered Plan Pays (on average) In-Network Out-of-Network Preventative Care Cleaning (prophylaxis) Frequency- Twice per Calendar Year Fluoride Treatments (No age limits) Oral Exams Periodontal Maintenance (2 additional payable with history of perio disease) Sealants (per tooth) X-rays 100% 100% Basic Care Anesthesia Fillings (Restrictions may apply to composite fillings) Inlays, Onlays, Veneers (subject to necessity requirements) Perio Surgery Repair & Maintenance of Crowns, Bridges & Dentures Root Canal Scaling & Root Planing (per quadrant) Simple Extractions Single Crowns Surgical Extractions 80% 80% Major Care Bridges and Dentures 80% 80% Orthodontia Limits: Child(ren) 60% 60% Annual Maximum Benefit $2000.00 $2000.00 Lifetime Orthodontia Benefit $2000.00 Dependent Age Limits 26 Genetic Testing and Surgical Procedures for High Risk Patients – Genetic Testing The appropriateness of genetic testing must be demonstrated in medical records which identify the patient as having a strong family history of breast cancer and/or ovarian cancer. Family history is defined by any of the following criteria: • Multiple relatives are affected; • Relatives including self were diagnosed at comparatively younger ages than is typical (prior to age 50); • Relatives have multiple primary cancers; • There is an autosomal dominant pattern that indicates that the patient is in a common genetic path with her affected relatives. Results A patient in any of the following circumstances may be considered high risk: • A mutated BRCA gene found by genetic testing; • Lobular neoplasia (fluid type 2), also referred to as LCIS or lobular carcinoma in situ (this pertains to removal of the uninvolved breast); • Atypical lobular hyperplasia, type 1.

Licensure/Certification. Classified employees who have earned a certificate or a degree, diploma, certification and/or licensure related to their job position may qualify for a stipend of $100/$300/$500 per year to a maximum of $2,500* per employee per year. (The maximum of $2,500 per employee is subject to review at the initial committee meeting.) In order to qualify for this additional stipend, the following criteria must be met: ■ Certificate / degree, diploma, certification and/or license must be specific to current job. ■ Receipt of certificate / degree, diploma, certification and/or license must be from a recognized state or national level trade or professional institution. ■ Knowledge/skill outcomes from the certificate / degree, diploma, certification and/or license must be designed to improve knowledge/skills that are beyond current job description requirements. ■ Requirements for the certificate / degree, diploma, certification and/or license must be completed primarily on the employee’s own time. Any full time classified employee who meets the established criteria may request the stipend pay by completing and submitting the application (APPENDIX B). Applications will be reviewed by the certification team, consisting of the Superintendent, Treasurer, and Classified Supervisor, who will make a determination as to eligibility for a stipend. LEVEL I - $100 STIPEND A certificate from an Adult/Continuing Education program, which requires 50 or more seat hours of instruction, will be considered for a $100 stipend. All classes must be on the same topic and apply to the employee’s job field. The employee must complete the entire course schedule for the program, subject to committee review. LEVEL II - $300 STIPEND A certificate from an Adult/Continuing Education program, which requires 100 or more seat hours of instruction, will be considered for a $300 stipend. All classes must be on the same topic and apply to the employee’s job field. The employee must complete the entire course schedule for the program, subject to committee review. LEVEL III- $500 STIPEND In order to be approved for certification/licensure pay at the $500 level, employees must have a degree, diploma, license or certification from the State of Ohio or a recognized state or national level trade or professional institution. Applications will be reviewed on a semi-annual basis by the certification team. Deadlines for applying for certification/licensure pay are the first working day of January and September. Applications should be submitted to the Treasurer and must be received by the end of the working day deadline. Applications received after the deadline will be reviewed for the following period. Xxxxxxxx Stipends will be paid with regular wages in the first pay in February for those meeting the January deadline and the first pay in October for those meeting the September deadline. If the certification or license is one that expires, it is the employee’s responsibility to submit documentation of renewal to the Treasurer. Failure to submit this documentation of renewal at the time of expiration will result in the loss of the certification/licensure stipend. APPENDIX A1- 2015/2016 School Year $150.00 Deductible Plan/ RX A 1 OF 6 XXXXX X. XXXXXXXX LOCAL SCHOOLS COMPREHENSIVE MAJOR MEDICAL BENEFITS Precertification Review: Precertification review is required for all inpatient Hospital confinements. For elective stays, certification is required at least 24 hours prior to admission. For emergency admissions, certification is required within 48 hours following admission. If preadmission Hospital certification is not utilized, your benefits under the plan will be reduced by an additional $500.00 deductible. All benefits will be based upon Allowed Amount Annual Maximum Amount Payable per Individual No Limit Network (PPO Providers) Physician/Office Services (co-pay) Primary Care Specialist Office Visit $10.00 $20.00 Surgical Services $10.00 $20.00 Immunizations $10.00 $20.00 Allergy Testing $10.00 Speech Therapy $20 co-pay Physical/Chiropractic/Occupational Therapy $20 co-pay Urgent Care $35.00 co-pay Calendar Year Deductible: $20.00 Per Individual $150.00 Per Family $300.00 Then: all eligible charges will be paid at 90% until the maximum out-of-pocket amount has been satisfied. With: 100% payment on eligible charges thereafter for that individual for the remainder of that calendar year. Maximum Out-of-Pocket Expense per Calendar Year (including the deductible): Per Individual $650.00 Per Family $1,300.00 Non-Network (Non-PPO Providers) Physician/Office Services (co-pay) Primary Care/Specialist Office Visit 20% after deductible Surgical Services 20% after deductible Immunizations 20% after deductible Allergy Testing 20% after deductible Speech Therapy 20% after deductible Physical/Chiropractic/Occupational Therapy 20% after deductible Urgent Care 20% after deductible Calendar Year Deductible: Per Individual $300.00 Per Family $600.00 Then: all eligible charges will be paid at 80% until the maximum out-of-pocket amount has been satisfied. With: 100% payment on eligible charges thereafter for that individual for the remainder of that calendar year. Maximum Out-of-Pocket Expense per Calendar Year (including the deductible): Per Individual $1,300.00 Per Family $2,600.00 COVERED SERVICES Subject to deductible and co-pay unless otherwise stated: Percentage Payable Network Non-Network Maximum Daily Room Charge (In Hospital) 90% 80% Private Room Rate (The Hospital's average semi-private room rate) 90% 80% Special Care Unit (ICU & CCU) 90% 80% Inpatient Miscellaneous Charges 90% 80% Inpatient Physicians Visits 90% 80% Preadmission Testing (deductible does not apply) 100% 100% Diagnostic X-ray and Lab 90% 80% Consultation Expenses 90% 80% Surgical Expense Benefits 90% 80% Voluntary Second Surgical Opinion (deductible does not apply) 100% 100% Outpatient Surgery 90% 80% Durable Medical Equipment 90% 80% Anesthesia 90% 80% Ambulance Services 90% 80% Emergency Room Treatment - Life Threatening Accident $75.00 co-pay Then 100% Then 100% Care received within 90 days as long as initial treatment is received within 72 hours of accident Emergency Room Treatment- Life Threatening Illness 90% 90% Emergency Room Treatment - Non-Life Threatening Accident. $75.00 co-pay Then 90% Then 80% Care received within 90 days as long as initial treatment is received within 72 hours of accident Emergency Room Treatment- Non Life Threatening $75.00 co-pay Then 90% Then 80% Physician Office Visits 90% 80% Injectable Prescription Drugs 90% 80% Percentage Payable Network Non-Network Deductible and Co-pay does not apply In Network: Wellness Benefits 100% 20% after deductible Women's Preventive Health 100% 20% after deductible Mammogram 100% 20% after deductible Pap Smear or Prostate Exam 100% 20% after deductible Maximum: 1 per Calendar Year Well Child Benefit (Age 1 - Age 21) 100% 20% after deductible Well Baby Benefit (Birth - Age 1) 100% 20% after deductible Colon and Rectal Exam (Age 40 and Over) 100% 20% after deductible Maximum: 1 per Calendar Year Genetic Testing (not subject to deductible) 100% Not Covered Therapy Services 90% 80% (Includes medically necessary cardiac rehabilitation, radiation therapy, chemotherapy, dialysis, physical therapy, speech therapy, and occupational therapy) Skilled Nursing/Rehabilitation Facility 90% 80% Private Duty Nursing 90% 80% Home Health Care 90% 80% Calendar Year Maximum: 100 visits Hospice Care Deductible does not apply Lifetime Maximum: 6 months 80% 80% Transplants 90% 80% Mental/Nervous Disorders Inpatient 90% 80% Outpatient 90% 80% Alcohol & Substance Abuse Inpatient 90% 80% Outpatient 90% 80% PPO PROVISIONS Treatment from Non-PPO (Non-Network) Providers in Certain Circumstances. In the following situations, services rendered by a Non-Network provider will be considered at the Network level: • Ancillary providers rendering care in a PPO facility (i.e.: pathologist, radiologist, anesthesiologist, emergencyroom physician); • If a Covered Person has no choice of network providers in the specialty that the Covered Person is seeking within the PPO service area; • If a Covered Person is out of the PPO service area and has a medical emergency requiring immediate care; • When a PPO provider utilizes the services of a Non-PPO provider for the reading or interpretation of x-ray or laboratory tests; • If a Covered Person does not live within a 30-mile radius of a PPO facility or is referred to an Out of Network Provider. • Eligible Dependent Children who reside outside of Primary PPO service area. However, in these instances, the individual may be responsible for charges in excess of the Allowed Amount. Please call the Claims Administrator if you believe any of these provisions apply to you. Prescription Drug Benefits as follows: Non-Formulary Formulary Generic Retail $25.00 co-pay $10.00 co-pay $5.00 co-pay Mail Order- 90 Day $50.00 co-pay $20.00 co-pay $10.00 co-pay Dental Plan Calendar Year Deductible In-Network $25.00 Out-of-Network $25.00 Family Limit- 2 per family Waived for Preventative Charges Covered Plan Pays (on average) In-Network Out-of-Network Preventative Care Cleaning (prophylaxis) Frequency- Twice per Calendar Year Fluoride Treatments (No age limits) Oral Exams Periodontal Maintenance (2 additional payable with history of perio disease) Sealants (per tooth) X-rays 100% 100% Basic Care Anesthesia Fillings (Restrictions may apply to composite fillings) Inlays, Onlays, Veneers (subject to necessity requirements) Perio Surgery Repair & Maintenance of Crowns, Bridges & Dentures Root Canal Scaling & Root Planing (per quadrant) Simple Extractions Single Crowns Surgical Extractions 80% 80% Major Care Bridges and Dentures 80% 80% Orthodontia Limits: Child(ren) 60% 60% Annual Maximum Benefit $2000.00 $2000.00 Lifetime Orthodontia Benefit $2000.00 Dependent Age Limits 26 Genetic Testing and Surgical Procedures for High Risk Patients – Genetic Testing The appropriateness of genetic testing must be demonstrated in medical records which identify the patient as having a strong family history of breast cancer and/or ovarian cancer. Family history is defined by any of the following criteria: • Multiple relatives are affected; • Relatives including self were diagnosed at comparatively younger ages than is typical (prior to age 50); • Relatives have multiple primary cancers; • There is an autosomal dominant pattern that indicates that the patient is in a common genetic path with her affected relatives. Results A patient in any of the following circumstances may be considered high risk: • A mutated BRCA gene found by genetic testing; • Lobular neoplasia (fluid type 2), also referred to as LCIS or lobular carcinoma in situ (this pertains to removal of the uninvolved breast); • Atypical lobular hyperplasia, type 1.